DE3490450C2 - Instrument for inserting surgical fasteners - Google Patents

Instrument for inserting surgical fasteners

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Publication number
DE3490450C2
DE3490450C2 DE19843490450 DE3490450A DE3490450C2 DE 3490450 C2 DE3490450 C2 DE 3490450C2 DE 19843490450 DE19843490450 DE 19843490450 DE 3490450 A DE3490450 A DE 3490450A DE 3490450 C2 DE3490450 C2 DE 3490450C2
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Germany
Prior art keywords
arrangement
anvil
instrument
holding
instrument according
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Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired
Application number
DE19843490450
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German (de)
Other versions
DE3490450T (en
Inventor
David Green
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United States Surgical Corp
Original Assignee
United States Surgical Corp
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Publication date
Application filed by United States Surgical Corp filed Critical United States Surgical Corp
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads

Abstract

In a surgical fastener applying instrument of the type in which the tissue is first clamped by operation of a lever mechanism, a releasable latch is included in the lever mechanism for releasably holding the tissue clamping elements at an intermediate latching position. In this position, the tissue to be fastened is enclosed but not fully clamped by the instrument so that the position of the instrument relative to the tissue can be adjusted without reopening the instrument.

Description

Die Erfindung betrifft ein Instrument zum Einsetzen von chirur­ gischen Befestigungselementen in Körpergeweben nach dem Oberbe­ griff des Patentanspruchs 1.The invention relates to an instrument for inserting surgery mechanical fasteners in body tissues according to the upper part handle of claim 1.

Ein derartiges Instrument ist aus der US-PS 43 83 634 bekannt. Dabei sind die Klammernhalteanordnungen gegenüber dem Amboß schwenkbar gelagert, aber auch begrenzt verschiebbar. Mit Hilfe von Schwenkhebeln wird die Klammernhalteanordnung zu dem Amboß hingeschwenkt, um das Gewebe zwischen diesen Teilen einzuklem­ men. Nach dem Einklemmen des Gewebes werden durch Betätigen eines Schwenkgriffes mehrere Metallklammern gleichzeitig durch das Gewebe hindurch vorgetrieben.Such an instrument is known from US-PS 43 83 634. The staple retention assemblies are opposite the anvil pivoted, but also slidable. With help by pivot levers, the staple holder assembly becomes the anvil pivoted to pinch the tissue between these parts men. After pinching the tissue, press one swivel handle through several metal clips at the same time advanced the tissue.

Da bei dem vorbekannten Instrument der Abstand zwischen der Klammernhalteanordnung und dem Amboß nicht einstellbar ist, kann man nach dem Einklemmen des Gewebes die Lage des Instruments gegenüber dem Gewebe nicht mehr ändern. Es ist nur möglich, das Instrument wieder zu öffnen und in eine andere Lage zu bringen, wenn die zunächst erzielte Lage nicht befriedigend ist.Since the distance between the Bracket holding arrangement and the anvil is not adjustable, can the position of the instrument after pinching the tissue no longer change compared to the tissue. It is only possible that Opening the instrument again and moving it to another position if the situation initially achieved is not satisfactory.

Aufgabe der Erfindung ist es daher, ein Instrument nach dem Ober­ begriff des Patentanspruchs 1 zu schaffen, bei dem eine Verände­ rung der Lage des Instruments gegenüber dem Gewebe möglich ist, ohne daß das Instrument wieder geöffnet werden muß. The object of the invention is therefore an instrument according to the Ober Concept of claim 1 to create, in which a change position of the instrument in relation to the tissue is possible, without having to open the instrument again.  

Erfindungsgemäß wird diese Aufgabe gelöst durch die kennzeich­ nenden Merkmale des Patentanspruchs 1. Die Antriebsanordnung be­ sitzt eine Rasteinrichtung, die dazu dient, die Anordnung zum Halten von Befestigungselementen in einer vorherbestimmten Stel­ lung zu verrasten, die zwischen der Stellung liegt, in der die Antriebseinrichtung beginnt, die Anordnung zum Halten von Be­ festigungselementen zu der Amboßanordnung hinzubewegen, und der Stellung, in der das Gewebe eingeklemmt ist. Dadurch kann die Lage des Instruments gegenüber dem Gewebe verändert werden, ohne daß das Instrument wieder geöffnet werden muß.According to the invention this object is achieved by the character nenden features of claim 1. The drive assembly be sits a latching device, which serves the arrangement for Hold fasteners in a predetermined position latching that lies between the position in which the Drive device begins the arrangement for holding Be Fixing elements to move to the anvil assembly, and the Position in which the tissue is jammed. This allows the Position of the instrument in relation to the tissue can be changed without that the instrument must be opened again.

Vorteilhafte Weiberbildungen der Erfindung sind in den Unteran­ sprüchen beschrieben.Advantageous female formations of the invention are in the Unteran sayings described.

Ein Ausführungsbeispiel der Erfindung wird nachstehend anhand der Zeichnung näher beschrieben. In dieser zeigtAn embodiment of the invention is described below the drawing described in more detail. In this shows

Fig. 1 schaubildlich ein Ausführungsbeispiel des erfindungsgemäßen Instruments zum Einset­ zen von chirurgischen Befestigungselemen­ ten, Fig. 1 a schematic view of an embodiment of the inventive instrument for Einset zen th of surgical Befestigungselemen,

Fig. 2 im Längsschnitt das Instrument gemäß der Fig. 1, Fig. 2 in longitudinal section, the instrument according to the Fig. 1,

Fig. 3 schaubildlich im Detail einen Teil des Instruments gemäß der Fig. 2, Fig. 3 diagrammatically in detail a part of the instrument according to the Fig. 2,

Fig. 4 in einer der Fig. 3 ähnlichen Dar­ stellung das Instrument in einer anderen Phase seines Arbeitsspiels, Fig. 4 in one of the Fig. 3 similar Dar position the instrument in a different phase of its operating cycle,

Fig. 5 in einer den Fig. 3 und 4 ähnlichen Darstellung, in der einige weitere Elemente sichtbar sind, das Instrument in einer weiteren Phase seines Arbeitsspiels, Fig. 5 in FIGS. 3 and 4 like representation are visible in a few further elements, the instrument, in a further phase of its operating cycle,

Fig. 6 in einer der Fig. 2 ähnlichen Dar­ stellung das Instrument in dem in Fig. 4 gezeigten Betriebs­ zustand, Fig. 6 in FIG. 2 Dar similar position in the instrument shown in Fig. 4 shown operation state,

Fig. 7 in einer der Fig. 7 ähnlichen Dar­ stellung das Instrument in dem in Fig. 5 gezeigten Betriebs­ zustand, Fig. 7 in one of the Fig. 7 Dar similar position in the instrument shown in Fig. 5 shown operation state,

Fig. 8 als Teildarstellung einen Schnitt längs der Linie 8-8 in Fig. 7 und Fig. 8 is a partial view of a section along the line 8-8 in Fig. 7 and

Fig. 9 in einer der Fig. 7 ähnlichen Dar­ stellung das Instrument in seiner weiteren Phase seines Arbeitsspiels. Fig. 9 in a similar to Fig. 7 Dar position the instrument in its further phase of its working cycle.

In dem dargestellten Ausführungsbei­ spiel besitzt das Instrument 10 zum Einsetzen von chirurgi­ schen Befestigungselementen einen langgestreckten Schaft 12, mit dem an seinem proximalen Ende ein Handgriff 14 fest ver­ bunden ist und mit dem an seinem distalen Ende eine Anord­ nung 16 zum Einsetzen von chirurgischen Befestigungselementen verbunden ist. Die Anordnung 16 zum Einsetzen von Befesti­ gungselementen hat zwei Hauptteile, und zwar eine Amboßanordnung oder einen Amboß 18, die bzw. der starr mit dem Schaft 12 verbunden ist, und eine Anordnung 20, die zum Halten von chirurgischen Befestigungselementen dient und gegenüber dem Amboß 18 schwenkbar und begrenzt gerad­ linig bewegbar gelagert ist. Die Anordnung 20 zum Halten von chirurgischen Befestigungselementen enthält zunächst eine Mehrzahl von U-förmigen chirurgischen Metallklammern 22 (Fig. 7), die in zwei parallelen Reihen angeordnet sind. Gegebenen­ falls kann man anstelle der Metallklammern 22 auch zwei­ teilige chirurgische Befestigungselemente aus Kunststoff verwenden, wie sie beispielsweise in der US-PS 40 60 089 (Noiles) gezeigt sind.In the illustrated embodiment, the instrument 10 for inserting surgical fasteners has an elongated shaft 12 with which a handle 14 is firmly connected at its proximal end and with which an arrangement 16 is connected at its distal end for inserting surgical fasteners is. The arrangement 16 has supply elements for inserting Fixed To two main parts, namely an anvil assembly or an anvil 18 and which is rigidly connected to the shaft 12, and an arrangement 20, which serves to hold surgical fasteners and opposite the anvil 18 is pivoted and linearly movable. The assembly 20 for holding surgical fasteners initially includes a plurality of U-shaped surgical metal clips 22 ( FIG. 7) arranged in two parallel rows. If necessary, instead of the metal clips 22 , two-part surgical fastening elements made of plastic can also be used, as are shown, for example, in US Pat. No. 4,060,089 (Noiles).

Die Anordnung 20 zum Halten der Befesti­ gungselemente ist im Bereich ihres in Fig. 2 unteren Endes mit dem übrigen Instrument verbunden, und zwar durch einen Zapfen 24, dessen Enden in Langlöcher 26 der Anordnung 20 zum Halten von Befestigungselementen eingreifen. Die Ver­ bindung stellt grundlegend eine Schwenklagerung dar. Die Langlöcher 26 erstrecken sich jedoch parallel zu der Längs­ achse des Schaftes 12, so daß sie eine gewisse geradlinige Bewegung der Anordnung 20 zum Halten von Befestigungsele­ menten gegenüber dem Amboß 18 gestatten. Zwischen der Amboßanordnung 18 und der Anordnung 20 zum Halten von Befestigungselementen ist eine vorgespannte Druckfeder 28 eingesetzt, die diese Teile auseinanderzudrücken trachtet, wie dies beispielsweise in den Fig. 1 und 2 gezeigt ist. Dabei liegt die Wirkungslinie der Feder 28 in Fig. 2 oberhalb des Zapfens 24, so daß die Feder 28 auch trachtet, den oberen Teil 20 der Anordnung 20 zum Halten von Befestigungselementen von dem benachbarten Teil des Ambosses 18 wegzuschwenken.The arrangement 20 for holding fastening elements is connected in the region of its lower end in FIG. 2 to the rest of the instrument, namely by a pin 24 , the ends of which engage in elongated holes 26 of the arrangement 20 for holding fastening elements. The United connection is basically a pivot bearing. However, the elongated holes 26 extend parallel to the longitudinal axis of the shaft 12 , so that they allow a certain linear movement of the arrangement 20 for holding fastening elements against the anvil 18 . Between the anvil arrangement 18 and the arrangement 20 for holding fastening elements, a prestressed compression spring 28 is inserted which tries to push these parts apart, as is shown, for example, in FIGS. 1 and 2. The line of action of the spring 28 in FIG. 2 lies above the pin 24 , so that the spring 28 also tries to pivot the upper part 20 of the arrangement 20 for holding fastening elements away from the adjacent part of the anvil 18 .

Die Anordnung 20 zum Halten von Befestigungs­ elementen trägt ferner an ihrem von den Langlöchern 26 ent­ fernten Ende einen Zapfen 30, der zu der Längsachse des Schaftes 12 im wesentlichen parallel und in der Anordnung 20 parallel zu seiner Längsachse hin- und herbewegbar ge­ lagert ist. Das proximale Ende des Zapfens 30 ist im oberen Ende der Blattfeder 32 festgelegt, die an ihrem unteren Ende mit der Anordnung 20 zum Halten von Befestigungselementen verbunden ist und beispielsweise gemäß den Fig. 1 und 2 den Zapfen in der proximalen Richtung belastet, so daß das distale Ende des Zapfens 30 zunächst nicht über die distale Seite der Anordnung 20 zum Halten von Befestigungselementen vorsteht.The arrangement 20 for holding fasteners also carries at its end distant from the elongated holes 26 a pin 30 which is parallel to the longitudinal axis of the shaft 12 and in the arrangement 20 parallel to its longitudinal axis reciprocating ge. The proximal end of the pin 30 is fixed in the upper end of the leaf spring 32 , which is connected at its lower end to the arrangement 20 for holding fasteners and, for example according to FIGS. 1 and 2, loads the pin in the proximal direction, so that the distal end of the pin 30 does not initially protrude beyond the distal side of the assembly 20 for holding fasteners.

In dem Schaft 12 ist eine Stößelanordnung 50 parallel zu der Längsrichtung des Schaftes 12 hin- und herbewegbar gelagert. Die Stößelanordnung 50 besitzt zwei Hauptteile, und zwar den Klemmstößel 52 und den Vortriebs­ stößel 54. Der Vortriebsstößel 54 ist in dem Klemmstößel 52 derart gelagert, daß der Vortriebsstößel 54 gegenüber dem Stößel parallel zu der Längsachse des Schaftes 12 hin- und herbewegbar ist. Mit dem Schaft 12 einerseits und einem von dem Vortriebsstößel 54 abwärts vorstehenden Lappen 58 andererseits ist eine vorgespannte Druckfeder 56 verbunden, die die beiden Teile der Stößelanordnung 50 in der proximalen Richtung elastisch belastet. Die von der Feder 56 ausgeübte Rückstellfederkraft wird auf den Klemmstößel 52 durch den Zapfen 60 übertragen, den der Klemmstößel 52 trägt und der ein in Fig. 7 gestrichelt angedeutetes Langloch des Vor­ triebsstößels 54 durchsetzt und am distalen Ende dieses Langloches angreift, so daß der Vortriebsstößel 54 sich gegenüber dem Klemmstößel 52 nur aus der in der Fig. 2 gezeigten Stellung dieser Teile bewegen kann. Im Ausgangs­ zustand des Instruments ist das distale Ende der Stößel­ anordnung 50 im Abstand von der proximalen Seitenwand der Anordnung 20 zum Halten von Befestigungselementen angeordnet.In the stem 12, a ram assembly 50 is reciprocable parallel to the longitudinal direction of the shaft 12 and stored forth. The plunger assembly 50 has two main parts, namely the clamping plunger 52 and the propulsion plunger 54th The jack tappet 54 is mounted in the clamping tappet 52 such that the jack tappet 54 can be moved back and forth relative to the tappet parallel to the longitudinal axis of the shaft 12 . A preloaded compression spring 56 is connected to the shaft 12, on the one hand, and a tab 58 projecting downward from the propulsion plunger 54 , which elastically loads the two parts of the plunger arrangement 50 in the proximal direction. The return spring force exerted by the spring 56 is transmitted to the clamp ram 52 by the pin 60, the clamping ram 52 carries and a dashed line in FIG. 7, indicated elongated hole of the Prior to operating the plunger 54 passes through and engages the distal end of this elongated hole, so that the propulsion plunger 54 can move relative to the clamping plunger 52 only from the position of these parts shown in FIG. 2. In the initial state of the instrument, the distal end of the plunger arrangement 50 is arranged at a distance from the proximal side wall of the arrangement 20 for holding fastening elements.

Im Bereich des proximalen Endes der Stößel­ anordnung 50 ist der Klemmteil 70 vorgesehen, der zwei Hauptteile besitzt, und zwar den Klemmhebel 72 und den mit dem Vortriebsstößel verbundenen Stößelmitnehmer 74. Der Klemmteil 70 ist durch einen Schwenkzapfen 76 mit dem Schaft 12 schwenkbar verbunden. Der Stößelmitnehmer 74 ist im Innern des Hebels 72 parallel zu dessen Längsachse hin- und herbewegbar gelagert. Zu diesem Zweck sind Zapfen 76 und 78 vorgesehen, die ein (in Fig. 7 gestrichelt ange­ deutetes) Langloch des Stößelmitnehmers 74 durchsetzen.In the area of the proximal end of the tappet arrangement 50 , the clamping part 70 is provided, which has two main parts, namely the clamping lever 72 and the tappet driver 74 connected to the propulsion tappet. The clamping part 70 is pivotally connected to the shaft 12 by a pivot pin 76 . The tappet driver 74 is mounted inside the lever 72 so that it can be moved back and forth parallel to its longitudinal axis. For this purpose, pins 76 and 78 are provided which penetrate an elongated hole (indicated by dashed lines in FIG. 7) of the tappet driver 74 .

Vorstehend wurde bereits erwähnt, daß die Rückstellfeder 56 die Stößelanordnung 50 proximal zu bewegen trachtet. Wie nachstehend näher beschrieben wird, greift während des größten Teils der Verschwenkung des Klemmteils 70 ein Teil des proximalen Endes der Stößelanordnung 50 in Fig. 2 unterhalb des Schwenkzapfens 76 an dem Klemm­ teil 70 an, so daß die Feder 56 über die Stößelanordnung 50 den Klemmteil in Fig. 2 im Gegensinn des Uhrzeigers um den Zapfen 76 zu verschwenken trachtet.It has already been mentioned above that the return spring 56 tries to move the plunger arrangement 50 proximally. As will be described in more detail below, during part of the pivoting of the clamping part 70 , part of the proximal end of the plunger arrangement 50 in FIG. 2 engages below the pivot pin 76 on the clamping part 70 so that the spring 56 on the plunger arrangement 50 engages the clamping part in Fig. 2 in the counterclockwise direction to pivot the pin 76 .

In dem Schaft 12 ist auf der proximalen Seite des Klemmteils 70 der Handgriff 90 um den Zapfen 92 schwenkbar gelagert. Der Zapfen 92 ist konzentrisch von einer nicht gezeigten Schraubenfeder umgeben, die trachtet, den Handgriff 90 im Uhrzeigersinn um den Zapfen 92 in eine Stellung zu verschwenken, in der der Handgriff 90 zunächst mit einem Sicherungsflügel 100 verrastet ist, der durch einen Zapfen 102 schwenkbar mit dem Handgriff 14 verbunden ist.In the shaft 12 , the handle 90 is pivotally mounted on the pin 92 on the proximal side of the clamping part 70 . The pin 92 is concentrically surrounded by a coil spring, not shown, which tries to pivot the handle 90 clockwise around the pin 92 into a position in which the handle 90 is initially locked with a locking wing 100 which is pivotable with a pin 102 the handle 14 is connected.

Jetzt sei die Arbeitsvorgangsfolge des Instruments erläutert. In den Fig. 1 bis 3 ist das Instru­ ment in seinem Ausgangszustand gezeigt. Zum Gebrauch des Instruments wird das festzulegende Gewebe 40 zwischen dem Amboß 18 und der Anordnung 20 zum Halten von Befestigungs­ elementen in das Instrument eingeführt und wird dann der Klemmteil 70 in die in den Fig. 4 und 6 gezeigte Zwischen­ stellung abwärtsgeschwenkt. Während dieser Bewegungsphase des Klemmteils 70 greift der am distalen Ende des Klemm­ hebels 72 ausgebildete Führungsflächenteil 80 a an dem An­ schlagflächenteil 62 a an, der am proximalen Ende des Klemm­ stößels 52 vorgesehen ist. Infolgedessen wird die Stößel­ anordnung 50 distal bewegt. Dabei tritt das distale Ende des Vortriebsstößels 54 durch ein nicht gezeigtes, vertikales Langloch der Blattfeder 32, während das distale Ende des Klemmstößels 52 an der Blattfeder 32 angreift und sie zur proximalen Seite der Anordnung 20 zum Halten von Befesti­ gungselementen hinbewegt. Infolgedessen wird das distale Ende des Zapfens 30 aus der distalen Seitenwand der Anordnung 20 zum Halten von Befestigungselementen ausgefahren und be­ ginnt die Verschwenkung der Anordnung 20 zum Halten von Befestigungselementen um den Zapfen 24 zu der Amboßanordnung 18 hin. Vorzugsweise ist die Feder 28 so stark, daß sie während dieser Bewegungsphase der Anordnung 20 zum Halten von Befestigungselementen den Zapfen 24 im Bereich des distalen Endes der Langlöcher 26 hält.Now the sequence of operations of the instrument is explained. In FIGS. 1 to 3, the instru ment is shown in its initial state. To use the instrument, the tissue to be fixed 40 is inserted between the anvil 18 and the arrangement 20 for holding fastening elements in the instrument and then the clamping part 70 is pivoted down into the intermediate position shown in FIGS . 4 and 6. During this movement phase of the clamping part 70 engages the guide surface part 80 a formed on the distal end of the clamping lever 72 on the striking surface part 62 a , which is provided on the proximal end of the clamping plunger 52 . As a result, the plunger assembly 50 is moved distally. The distal end of the jack tappet 54 passes through a vertical slot (not shown) of the leaf spring 32 , while the distal end of the clamping tappet 52 engages the leaf spring 32 and moves them to the proximal side of the arrangement 20 for holding fastening elements. As a result, the distal end of the pin 30 extends from the distal side wall of the fastener assembly 20 and the pivoting of the fastener assembly 20 about the pin 24 begins toward the anvil assembly 18 . The spring 28 is preferably so strong that it holds the pin 24 in the region of the distal end of the elongated holes 26 during this movement phase of the arrangement 20 for holding fastening elements.

Ungefähr in dem Zeitpunkt, in dem der von dem Zapfen 24 entfernte Teil der distalen Seiten­ wand der Anordnung 20 zum Halten von Befestigungselementen an der Amboßanordnung 18 angreift, greift der Führungs­ flächenteil 80 b an dem Anschlagflächenteil 62 b an. Der Führungsflächenteil 80 b ist ein Teil eines Vorsprunges, der von der übrigen Führungsfläche 80 a, 80 c vorsteht. Der Anschlagflächenteil 62 b ist eine dazu komplementäre Vertiefung in der übrigen Anschlagfläche 62 a, 62 c. Der Führungsfächenteil 80 b und der Anschlagflächenteil 62 b sind gegenüber dem übrigen Teil der Führungs- bzw. An­ schlagfläche so abgewinkelt, daß sie als Rasteinrichtung wir­ ken. Wenn der Klemmteil 70 so weit verschwenkt worden ist, daß der Führungsflächenteil 80 b und der Anschlagflächenteil 62 b aneinander angreifen, wirken diese Flächenteile derart miteinander zusammen, daß sie dem Rückwärtsschwenken des Klemmteils 70 einen Widerstand entgegensetzen. Durch die Rückstellfeder 56 ist die Stößelanordnung zwar ständig in der proximalen Richtung belastet, aber nicht genügend stark, um die Rastwirkung der miteinander zusammenwirkenden Flächenteile 80 b und 62 b zu überwinden. Daher bleibt das Instrument infolge der Rastwirkung der Flächenteile 80 b und 62 b in der in den Fig. 4 und 6 gezeigten Stellung, auch wenn die Bedienungsperson den Klemmteil 70 vollständig von dem von Hand ausgeübten Verschwenkungsdruck entlastet. Daher wird hier manchmal gesagt, daß das in dieser Stellung befindliche Instrument in einer Zwischenstellung verrastet ist. At about the time when the part of the distal side removed from the pin 24 of the arrangement 20 for holding fastening elements on the anvil arrangement 18 engages, the guide surface part 80 b engages the stop surface part 62 b . The guide surface part 80 b is part of a projection which protrudes from the remaining guide surface 80 a , 80 c . The stop surface part 62 b is a complementary recess in the remaining stop surface 62 a , 62 c . The guide compartment part 80 b and the stop surface part 62 b are angled relative to the remaining part of the guide or to the impact surface so that they act as a locking device. If the clamping part 70 has been pivoted so far that the guide surface part 80 b and the stop surface part 62 b engage each other, these surface parts interact with one another in such a way that they oppose the backward pivoting of the clamping part 70 . Due to the return spring 56 , the tappet arrangement is constantly loaded in the proximal direction, but is not sufficiently strong to overcome the locking action of the interacting surface parts 80 b and 62 b . Therefore, the instrument remains due to the locking action of the surface parts 80 b and 62 b in the position shown in FIGS . 4 and 6, even if the operator completely relieves the clamping part 70 from the pivoting pressure exerted by hand. Therefore it is sometimes said here that the instrument in this position is locked in an intermediate position.

In der Fig. 6 erkennt man, daß bei in der Zwischenstellung verrastetem Instrument das festzu­ legende Gewebe 40 von der Anordnung 16 zum Einsetzen von chirurgischen Befestigungselementen vollständig umschlossen ist. Dabei steht der von dem Zapfen 24 entfernte Teil der Anordnung 20 zum Halten von Befestigungselementen mit der Amboßanordnung 18 in Berührung oder fast in Berührung und ist das distale Ende des Zapfens 30 aus der Anordnung 20 zum Halten von Befestigungselementen ausgefahren und hat es mit dem Eintritt in die Ausnehmung 42 der Amboßanordnung 18 begonnen. Dagegen ist das Gewebe noch nicht mit dem vollen Klemmdruck beaufschlagt. Daher kann erforderlichen­ falls die Lage des Instruments gegenüber dem Gewebe leicht verändert werden, ohne daß das Instrument wieder geöffnet wird. Während dieser Lageänderung kann das Gewebe nicht aus dem Instrument heraustreten, weil das Gewebe in der vorstehend beschriebenen Weise von dem Instrument voll­ ständig umschlossen ist.In FIG. 6, it is seen that when latched in the intermediate position the instrument festzu legend tissue 40 is completely enclosed by the assembly 16 for the insertion of surgical fasteners. The portion of the fastener holding assembly 20 remote from the pin 24 is or almost in contact with the anvil assembly 18 and the distal end of the pin 30 is extended from the fastener holding assembly 20 and has entered it the recess 42 of the anvil assembly 18 started. On the other hand, the fabric is not yet subjected to the full clamping pressure. Therefore, if necessary, the position of the instrument relative to the tissue can be changed slightly without opening the instrument again. During this change in position, the tissue cannot emerge from the instrument because the tissue is completely enclosed by the instrument in the manner described above.

Wenn die das Instrument bedienende Person mit der Anordnung des Gewebes in dem Instrument zufrieden ist, schwenkt die Bedienungsperson den Klemmteil 70 weiter abwärts in eine zu dem Schaft 12 parallele Stellung. Während dieser Bewegungsphase des Klemmteils 70 bewirkt der Führungsflächenteil 80 c durch seinen Angriff an dem Anschlagflächenteil 62 c, daß die Stößelanordnung 50 weiter distal bewegt wird. Dadurch wird die Feder 32 stärker gespannt, so daß sie die Anordnung 20 zum Halten von Befestigungselementen näher an die Amboßanordnung 18 heran­ bewegt. Dabei wird die Feder 28 zusammengedrückt, der Zapfen 24 zu dem proximalen Ende der Langlöcher 26 hinbewegt und der Zapfen 30 weiter in die Ausnehmung 42 ausgefahren.When the person operating the instrument is satisfied with the placement of the tissue in the instrument, the operator pivots the clamp portion 70 further down to a position parallel to the shaft 12 . During this movement phase of the clamping part 70 , the guide surface part 80 c, by engaging the stop surface part 62 c , causes the plunger arrangement 50 to be moved further distally. As a result, the spring 32 is tensioned more so that it moves the assembly 20 for holding fasteners closer to the anvil assembly 18 . The spring 28 is compressed, the pin 24 is moved towards the proximal end of the elongated holes 26, and the pin 30 is extended further into the recess 42 .

Wenn der Klemmteil 70 vollständig in die in den Fig. 5, 7 und 8 gezeigte Stellung verschwenkt worden ist, in der er zu dem Schaft 12 parallel ist, stützt sich das proximale Ende des Klemmteils 70 an einem Innenteil des Handgriffes 14 ab. In dieser Stellung ist der Klemm­ teil 70 verrastet, weil der Berührungspunkt zwischen den Flächenteilen 80 c und 62 c oberhalb einer zu dem Schaft 12 parallelen, in Fig. 7 horizontalen Linie liegt, die durch den Zapfen 76 geht. Im Bereich des proximalen Endes des Stößelmitnehmers 74 tritt der Handgriffeinsatz 94 in ein Langloch des Klemmteils 70 ein, und der Zapfen 24 befindet sich in der Nähe des proximalen Endes der Langlöcher 26. Die Anordnung 20 zum Halten von Befestigungselementen ist zu der Amboßanordnung 18 im wesentlichen parallel, und das Gewebe 40 ist zwischen diesen beiden Anordnungen einge­ klemmt. Jetzt ist das Instrument für das Einsetzen der Befestigungselemente in das Gewebe bereit.When the clamping part 70 has been pivoted completely into the position shown in FIGS . 5, 7 and 8, in which it is parallel to the shaft 12 , the proximal end of the clamping part 70 is supported on an inner part of the handle 14 . In this position, the clamping part 70 is locked because the point of contact between the surface parts 80 c and 62 c lies above a line parallel to the shaft 12 in FIG. 7, which goes through the pin 76 . In the area of the proximal end of the plunger driver 74 , the handle insert 94 enters an elongated hole in the clamping part 70 , and the pin 24 is located in the vicinity of the proximal end of the elongated holes 26 . The assembly 20 for holding fasteners is substantially parallel to the anvil assembly 18 and the tissue 40 is clamped between these two assemblies. The instrument is now ready to insert the fasteners into the tissue.

Zum Einsetzen der Befestigungselemente wird der Sicherungsflügel 100 in Fig. 9 abwärtsgeschwenkt und der Handgriff 90 zu dem Handgriff 14 hingeschwenkt. Infolge­ dessen bewegt der Handgriffeinsatz 94 den Stößelmitnehmer 74 in der distalen Richtung, so daß der Stößelmitnehmer 74 mit seinem distalen Ende an dem Vortriebsstößel 54 an­ greift und diesen distal bewegt. Infolgedessen tritt das distale Ende des Vortriebsstößels 54 in ein Langloch in der proximalen Seitenwand der Anordnung 20 zum Halten von Be­ festigungselementen ein und bewegt mehrere je einem Befestigungselement zugeordnete Einzelstößel 34 in der distalen Richtung. Infolgedessen schieben die Einzel­ stößel 34 je eine zugeordnete Klammer 22 aus der Anordnung 20 zum Halten von Befestigungselementen heraus. Die Schenkel jeder Klammer treten durch das Gewebe hindurch und werden zum Festlegen des Gewebes von der Amboßanordnung 18 gebogen.To insert the fastening elements, the securing wing 100 is pivoted downward in FIG. 9 and the handle 90 is pivoted towards the handle 14 . As a result, the handle insert 94 moves the plunger driver 74 in the distal direction, so that the plunger driver 74 engages with its distal end on the jacking plunger 54 and moves it distally. As a result, the distal end of the propulsion plunger 54 enters an elongated hole in the proximal side wall of the arrangement 20 for holding fastening elements and moves a plurality of individual plungers 34 each associated with a fastening element in the distal direction. As a result, the individual plunger 34 each slide an associated bracket 22 out of the assembly 20 for holding fasteners. The legs of each clip pass through the tissue and are bent by the anvil assembly 18 to secure the tissue.

Zum Entfernen des festgelegten Gewebes aus dem Instrument läßt die Bedienungsperson zunächst den Handgriff 90 los, so daß die Rückstellfeder 56 den Stößel 54 und den Stößelmitnehmer 74 zurückzieht und den Handgriff 90 in seine Ausgangsstellung zurückstellt. Dann drückt die Bedienungsperson das proximale Ende des Klemm­ teils 70 aufwärts, wobei sie die Rückstellfederkraft über­ windet, die in der vorstehend beschriebenen Weise den Klemmteil während des Einsetzens von Befestigungselementen verrastend niederhält. Wenn die Rastkraft überwunden ist, zieht die Rückstellfeder 56 die Stößelanordnung 50 ein und schwenkt den Klemmteil in den Fig. 1, 2, 6, 7 und 8 im Gegensinn des Uhrzeigers. Dabei kann der Klemmteil 70 in der Zwischenstellung in der der Führungsflächenteil 80 b und der Anschlagflächenteil 62 b eine Verrastung bewirken, angehalten werden oder nicht. Wenn der Klemmteil 70 in der genannten Stellung nicht angehalten wird, bewegt er sich mit Unterstützung einer schwachen von Hand ausgeübten Kraft weiter. Am Ende des Rückstellhubes des Instruments befinden sich der Klemmteil 70, die Stößelanordnung 50 und die Anordnung 20 zum Halten von Befestigungselementen alle in ihren beispielsweise in den Fig. 1 und 2 gezeigten Ausgangsstellungen und kann das festgelegte Gewebe aus dem Instrument herausgenommen werden.To remove the fixed tissue from the instrument, the operator first releases the handle 90 so that the return spring 56 pulls back the plunger 54 and the plunger driver 74 and returns the handle 90 to its starting position. Then the operator pushes the proximal end of the clamp member 70 upward, overcoming the return spring force which, in the manner described above, holds the clamp member in a latching manner during the insertion of fasteners. When the latching force is overcome, the return spring 56 retracts the plunger arrangement 50 and pivots the clamping part in FIGS . 1, 2, 6, 7 and 8 in the counterclockwise direction. Here, the clamping part 70 in the intermediate position in which the guide surface part 80 b and the stop surface part 62 b bring about a latching, stopped or not. If the clamping part 70 is not stopped in the stated position, it continues to move with the assistance of a weak, manual force. At the end of the reset stroke of the instrument, the clamping part 70 , the plunger arrangement 50 and the arrangement 20 for holding fastening elements are all in their starting positions, for example shown in FIGS. 1 and 2, and the defined tissue can be removed from the instrument.

Es versteht sich, daß der Erfindungsgedanke nur beispielsweise erläutert worden ist und daß der Fachmann im Rahmen des Erfindungsgedankens verschiedene Abänderungen vornehmen kann. Beispielsweise können, wie vorstehend erwähnt wurde, anstelle der in der vorstehend beschriebenen Ausführungsform verwendeten Metallklammern auch zwei­ teilige chirurgische Befestigungselemente der in der US-PS 40 60 089 dargestellten Art verwendet werden.It is understood that the inventive concept has only been explained for example and that the expert Various changes within the scope of the inventive concept can make. For example, as above was mentioned instead of that described in the above  Embodiment also used two metal clips part surgical fasteners in the US-PS 40 60 089 shown type can be used.

Claims (8)

1. Instrument zum Einsetzen von chirurgischen Befestigungselemen­ ten in Körpergewebe, bestehend aus
einer Antriebseinrichtung, die eine Amboßanordnung trägt,
und einer Anordnung zum Halten von Befestigungselementen, die gegenüber der Amboßanordnung bewegbar gelagert und von der Antriebseinrichtung zu der Amboßanordnung hinbewegbar ist, um das festzulegende Körpergewebe dadurch einzuklemmen,
dadurch gekennzeichnet, daß die Antriebseinrichtung eine Rasteinrichtung (62 b, 80 b) besitzt, die dazu dient, die Anordnung (20) zum Halten von Befestigungselementen (22) in einer vorherbestimmten Stellung zu verrasten, die zwischen der Stellung liegt, in der die An­ triebseinrichtung beginnt, die Anordnung (20) zum Halten von Befestigungselementen (22) zu der Amboßanordnung (18) hinzu­ bewegen, und der Stellung, in der das Gewebe (40) eingeklemmt ist.1. Instrument for inserting surgical fastening elements into body tissue, consisting of
a drive device which carries an anvil arrangement,
and an arrangement for holding fastening elements, which is movably mounted with respect to the anvil arrangement and can be moved from the drive device to the anvil arrangement in order thereby to pinch the body tissue to be fixed,
characterized in that the drive means has a locking means ( 62 b , 80 b) which serves to lock the arrangement ( 20 ) for holding fasteners ( 22 ) in a predetermined position which lies between the position in which the on Drive device begins to move the assembly ( 20 ) for holding fasteners ( 22 ) to the anvil assembly ( 18 ) and the position in which the tissue ( 40 ) is pinched. 2. Instrument nach Anspruch 1, dadurch gekennzeichnet, daß die Antriebseinrichtung ein schwenkbares Betätigungsglied (70) besitzt und die Rasteinrichtung (62 b, 80 b) geeignet ist, das Betätigungsglied (70) in einer vorherbestimmten Stellung zu verrasten. 2. Instrument according to claim 1, characterized in that the drive device has a pivotable actuator ( 70 ) and the latching device ( 62 b , 80 b) is suitable for latching the actuator ( 70 ) in a predetermined position. 3. Instrument nach Anspruch 2, dadurch gekennzeichnet, daß die Antriebseinrichtung einen Stößel (50) besitzt, der mit der Anordnung (20) zum Halten von Befestigungselementen (22) in Wirkungsverbindung steht und durch ein Verschwenken des Be­ tätigungsgliedes (70) geradlinig verschiebbar ist.3. Instrument according to claim 2, characterized in that the drive device has a plunger ( 50 ) which is in operative connection with the arrangement ( 20 ) for holding fasteners ( 22 ) and by pivoting the loading actuating member ( 70 ) is linearly displaceable . 4. Instrument nach Anspruch 3, dadurch gekennzeichnet, daß an dem Betätigungsglied (70) eine Führungsfläche (80) und an dem Stößel (50) eine an der Führungsfläche (80) anliegende Anschlagfläche (62) vorgesehen ist.4. Instrument according to claim 3, characterized in that on the actuating member ( 70 ) a guide surface ( 80 ) and on the plunger ( 50 ) on the guide surface ( 80 ) abutting stop surface ( 62 ) is provided. 5. Instrument nach Anspruch 4, dadurch gekennzeichnet, daß die Rasteinrichtung miteinander zusammenwirkende Segmente der Füh­ rungsfläche (80 a, 80 b, 80 c) und der Anschlagfläche (62 a, 62 b, 62 c) umfaßt.5. Instrument according to claim 4, characterized in that the locking device cooperating segments of the Füh guide surface ( 80 a , 80 b , 80 c) and the stop surface ( 62 a , 62 b , 62 c) . 6. Instrument nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, daß die Amboßanordnung (18) und die Anordnung (20) zum Halten von Befestigungselementen (22) beide langge­ streckt sind und die Längsachsen der Amboßanordnung (18) und der Anordnung (20) zum Halten von Befestigungselementen (22) während der Betätigung der Antriebseinrichtung stets in einer Ebene liegen.6. Instrument according to one of the preceding claims, characterized in that the anvil arrangement ( 18 ) and the arrangement ( 20 ) for holding fastening elements ( 22 ) are both elongated and the longitudinal axes of the anvil arrangement ( 18 ) and the arrangement ( 20 ) for Holding fasteners ( 22 ) always lie in one plane during the actuation of the drive device. 7. Instrument nach Anspruch 6, dadurch gekennzeichnet, daß die Anordnung (20) zum Halten von Befestigungselementen (22) im Bereich eines ihrer Enden um ein Ende der Amboßanordnung (18) schwenkbar gelagert ist und im Bereich ihres von der Schwenk­ lagerung (24) entfernten Endes eine Einrichtung (30) besitzt, die dazu dient, an der Amboßanordnung (18) im Bereich deren von der Schwenklagerung (24) entfernten Endes anzugreifen, wenn die Anordnung (20) zum Halten von Befestigungselementen (22) um einen vorherbestimmten Winkel zu der Amboßanordnung (18) hin verschwenkt worden ist.7. Instrument according to claim 6, characterized in that the arrangement ( 20 ) for holding fasteners ( 22 ) is pivotally mounted in the region of one of its ends around one end of the anvil arrangement ( 18 ) and in the region of its pivoting bearing ( 24 ) distal end has means ( 30 ) for engaging the anvil assembly ( 18 ) in the area of the end thereof remote from the pivot bearing ( 24 ) when the assembly ( 20 ) for holding fasteners ( 22 ) is closed by a predetermined angle the anvil assembly ( 18 ) has been pivoted. 8. Instrument nach Anspruch 7, dadurch gekennzeichnet, daß die Rasteinrichtung (62 b, 80 b) wirksam wird, wenn die Einrichtung (30) zum Angriff an der Amboßanordnung (18) an dieser angreift.8. Instrument according to claim 7, characterized in that the latching device ( 62 b , 80 b) takes effect when the device ( 30 ) engages the anvil assembly ( 18 ) to attack it.
DE19843490450 1983-10-04 1984-09-10 Instrument for inserting surgical fasteners Expired DE3490450C2 (en)

Applications Claiming Priority (2)

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US06/538,830 US4530453A (en) 1983-10-04 1983-10-04 Surgical fastener applying apparatus
PCT/US1984/001436 WO1985001428A1 (en) 1983-10-04 1984-09-10 Surgical fastener applying apparatus

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DE3490450C2 true DE3490450C2 (en) 1987-10-08

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DE19843490450 Pending DE3490450T (en) 1983-10-04 1984-09-10 Instrument for inserting surgical fasteners

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US (1) US4530453A (en)
EP (1) EP0136950B1 (en)
JP (1) JPS60501993A (en)
AT (1) ATE28123T1 (en)
AU (1) AU568879B2 (en)
BR (1) BR8407102A (en)
CA (1) CA1235973A (en)
DE (2) DE3490450C2 (en)
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WO (1) WO1985001428A1 (en)

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Also Published As

Publication number Publication date
JPS6332457B2 (en) 1988-06-30
EP0136950A3 (en) 1985-05-22
AU3337184A (en) 1985-04-18
JPS60501993A (en) 1985-11-21
GB2158387B (en) 1987-02-04
GB8513119D0 (en) 1985-06-26
BR8407102A (en) 1985-08-27
GB2158387A (en) 1985-11-13
ATE28123T1 (en) 1987-07-15
DE3490450T (en) 1985-10-17
EP0136950B1 (en) 1987-07-08
US4530453A (en) 1985-07-23
CA1235973A (en) 1988-05-03
EP0136950A2 (en) 1985-04-10
WO1985001428A1 (en) 1985-04-11
AU568879B2 (en) 1988-01-14

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